Experts from the St Petersburg University Clinic: early diagnosis is the key to successful treatment of breast cancer

There are around 70,000 new cases of breast cancer in Russia every year. Experts say that it is a very common disease: it is diagnosed in one in 12 women, and also occurs in men. However, there is still a lack of awareness of this disease in Russia. Due to ignorance of the practice of self-diagnosis and prevention, women delay going to the doctor. This means that the diagnosis is not made in the early stages of the disease, which complicates its treatment.

The main goal of the Mammoforum held at the St Petersburg University Clinic was to bring together highly qualified doctors and patients. The forum included presentations by: oncologists, pathologists and rehabilitation therapists from the leading medical centres of the country; and stories from patients about their experiences of fighting the disease.

In 1993, the World Health Organization designated October as breast cancer awareness month.

Dmitry Shkarupa, Assistant Director for Medical Care Administration at the Pirogov Clinic of High Medical Technologies at Petersburg University, noted that the World Health Organization has reported breast cancer to be the most frequent oncological pathology in the world. At the same time, the prognosis for treatment is favourable, and the survival rate of patients with this type of cancer is over 90%. 'These are the figures for high-income countries. In low-income countries, it barely reaches 40%', said Dr Shkarupa. He added that the statistics should focus on the availability of medical care and patients' awareness rather than on the standard of living of the patients. These are the two factors that have the biggest impact. High mortality is caused by irresponsibility in matters of one's own health and a long and difficult path to qualified help.

According to Dmitry Shkarupa, it is not only the distance between the doctor and the patient. It is also the training of medical personnel, and the number of doctors who are ready to: respond to the latest trends in evidentiary medicine; and be open to the patient. It is this openness that determines the outcome of treatment. It is this openness that influences the outcome of treatment. Life satisfaction among patients who have beaten cancer, especially in recent years, has been increasing. This is due, among other things, to the fact that most breast surgeries today are organ-preserving. Aleksandr Petrachkov, an oncologist at the Pirogov Clinic of High Medical Technologies at St Petersburg University, noted that at the Pirogov Clinic this figure reaches 70%.

As early as the 1980s, studies confirmed that there is virtually no difference in recurrence rate and survival between breast removal and tumour resection. Both operations appear to be equally effective.

Aleksandr Petrachkov, oncologist at the Pirogov Clinic of High Medical Technologies at St Petersburg University

Of course, the choice of treatment depends on many factors, including tumour size, number of foci and contraindications to radiotherapy.

The surgery, whatever it may be, is followed by a decision on whether or not additional chemotherapy is needed. This depends on the type of tumour, age, comorbidities, and molecular genetic characteristics. Iuliia Gronskaia, a leading expert in chemotherapy and oncologist at the University Clinic, emphasised that such treatment reduces the risk of relapse but dramatically reduces the quality of life: 'It is a highly toxic treatment which introduces cellular poisons into the body. This means that not only the tumour but also healthy cells suffer.' Chemotherapy often leads to acute intoxication in the form of nausea, weakness, muscle and joint pain, as well as delayed neurocognitive dysfunction, and reduced fertility. It can also have a quite significant impact on career and personal life. With this in mind, the decision to have adjuvant (preventive) chemotherapy is not an easy one, especially in cases of hormone-dependent breast tumours. Doctors increasingly say that medicine is now moving towards a path where the patients themselves become  active participants in the decision-making process about treatment. The oncologists use statistics, progression risk calculators and molecular tests to explain to the patient the benefits of a particular treatment.

Experts have observed that genetic testing can also be useful in preventing the disease.

Although cancer cannot be avoided by preventive measures, it is possible to estimate how likely a particular person is to get cancer. It is higher if there is a mutation in the genes. This can be checked by full-exome sequencing – a genetic test. The test should only be performed once in a lifetime, because no changes will occur in the genes during the course of a person's life. Until recently, a person learning about a ‘defect’ could not radically change the situation. Today, however, there are more and more centres in Russia that offer preventive surgery – removal of the breast and plastic surgery – if there is a high risk of developing breast cancer.

Rehabilitation is an important phase of treatment. This is usually understood as post-treatment measures that are carried out after the main treatment, be it medication or surgery. Doctors emphasise, however, that in the case of breast cancer, there must be a stage zero rehabilitation, which takes place as soon as the diagnosis is made. At this stage, it is important for the patient to receive psychological support, as well as to learn what exactly will happen during the treatment and what practical skills will be needed in the future. In the case of breast cancer, for example, it is also important to know: what underwear to wear; how to restrict physical activity; and what complications may arise. One of the frequent complications of breast surgery, for instance, is lymphedema, the post-mastectomy syndrome. More than 10 million people worldwide are affected by this disease. It is a process in which the transport of lymph through the lymphatic vessels is disrupted, causing severe swelling. Doctors believe that the patient should be prepared for lymphedema after surgery. This will help them to: live through this phase more easily; get timely treatment; and use preventive measures, such as choosing compression underwear and learning how to use it.

During the forum, experts repeatedly reminded that it is important to detect cancer as early as possible, in order to have successful treatment. To do this, doctors recommend X-ray mammography. In the absence of symptoms, it should be done for the first time at the age of 35-40. People aged 40-50 should undergo it every two years, after 50 – once a year, and after 60 – again, once in two years. It is necessary to reduce the risk factors that a person can control: not to abuse alcohol; control body weight; and listen to one's own body.